What can you do to have a healthy pregnancy?

You may be happy and
excited to find out that you're pregnant. And you may be a little nervous or worried. If this will be your first
child, you may even feel overwhelmed by all of the things you need to know
about having a baby. There is a lot to learn. But you don't have to know
everything right away. You can read all about pregnancy now, or you can learn
about each stage as your pregnancy goes on.

Pregnancy is measured in
trimesters from the first day of your last menstrual
period, totaling 40 weeks. But a full-term
pregnancy can deliver between 37 weeks and 42 weeks.

During your pregnancy,
you'll have tests to watch for certain problems that could occur. With all the
tests you'll have, you may worry that something will go wrong. But most women
have healthy pregnancies. If there is a problem, these tests can find it early
so that you and your doctor or midwife can treat it or watch it to help improve
your chance of having a healthy baby.

Taking great care of
yourself is the best thing you can do for yourself and your baby. Everything
healthy that you do for your body helps your growing baby. Rest when you need
it, eat well, and exercise regularly. Drink plenty of
water before, during, and after you are active. This is very important when
it's hot out.

You'll need to have
regular checkups. At every visit, your doctor or midwife will weigh you and
measure your belly to check your baby's growth. You'll also get blood and urine
tests and have your blood pressure checked.

It's important to avoid
tobacco smoke, alcohol and drugs, chemicals, and radiation (like X-rays). These
can harm you and the baby.

What kinds of exams and tests will you have?

Your
first prenatal exam gives your doctor or midwife important information for
planning your care. You'll have a pelvic exam and urine and blood tests. You'll
also have your blood pressure and weight checked. The urine and blood tests are
used for a pregnancy test and to tell whether you have low iron levels (are
anemic) or have signs of infection.

At
each prenatal visit you'll be weighed, have your belly measured, and have your
blood pressure and urine checked. Go to all your appointments. Although these
quick office visits may seem simple and routine, your doctor is watching for
signs of possible problems like
high blood pressure.

In some medical
centers, you can have screening in your first
trimester to see if your baby has a chance of having
Down syndrome or another genetic problem. The test
usually includes a blood test and an
ultrasound.

During your second trimester,
you can have a blood test (triple or quadruple screen test) to see if you have
a higher-than-normal chance of having a baby with birth defects. Based on the
results of the tests, you may be referred to a geneticist for further
discussion. Or you may have other tests to find out for sure if your baby has a
birth defect.

Late in your second trimester, your blood sugar
will be checked for diabetes during pregnancy (gestational diabetes). Near the end of your pregnancy, you will have tests to look
for infections that could harm your newborn.

What changes can you expect in your body and your emotions?

You will go through some amazing changes during pregnancy. Your body, emotions, and relationships will all do some growing. These changes are common, but some may be a challenge.

Every woman feels these changes in her own way. Even the way she changes can change. In the beginning of your pregnancy, you may feel so tired that you can barely keep your head up. But at other times, you may have trouble sleeping.

Many women feel nauseated in the morning (morning sickness) or at other times of day in the early part of pregnancy. But some women never have this problem. Your breasts will get larger and may feel tender. Throughout your pregnancy, you may get heartburn or crave certain foods, and you may have aches and pains. You also may enjoy the flutters of your baby moving and kicking.

Your emotions may move around too. Even women who are happy about their pregnancy may worry a lot about their babies. They may even feel some sadness at the coming changes in their lifestyles.

Your relationship with your partner and other children you may have also may change. Talk with your partner and with your doctor if you have concerns about how you're feeling.

Prenatal Visits and Tests

The first test you may have is the one you take at home to see if you're pregnant. After you know you're pregnant, you will have a series of tests throughout your pregnancy to make sure you and your baby are healthy.

At-home pregnancy test

If you think you might be
pregnant, you can use a
home pregnancy test as soon as you think you have missed your period.

Checkups and tests after you know you're pregnant

As soon as you
know you're pregnant, make an appointment with your doctor or certified
midwife. Your first prenatal visit will provide information that
can be used to check for any problems as your pregnancy progresses. It's also a good time to think about how you want to partner with your doctor or midwife.

Good care during pregnancy includes
regularly scheduled prenatal exams. At each prenatal
visit, you'll be weighed, have your abdomen measured, and have your blood
pressure and urine checked. Use this time to discuss with your doctor or midwife your list of pregnancy
concerns or problems.

At different times in your
pregnancy, you may have additional exams and tests performed. Although some
are routine, others are only done when you ask for them, when a problem is suspected, or if you have a
risk factor for a problem.

Second-trimester exams and tests may include fetal
ultrasound and electronic fetal heart monitoring. Later in the
second trimester, you will have an oral glucose screening test for possible
gestational diabetes. If you have
Rh-negative blood, you may have an antibody screening test and
will receive an injection of Rh immunoglobulin. Screening tests help your doctor look for a certain disease or condition before any symptoms appear.

Testing For Birth Defects

Tests in the first and second trimester can show if your baby has a birth defect. It's your choice whether to have these tests. You and your partner can talk to your
doctor or midwife about birth defects tests.

You
can choose from different kinds of tests. If you are worried about the chance of a birth defect, you might want test results as early as possible. If your risk for having
a baby with a birth defect is very low or if knowing that your baby has a birth defect wouldn't change your plans, you might decide not to have early tests. Or you might choose not to have these tests at all.

Eat well

Try to get proper nutrition. Pay close attention to your folic acid, iron, and calcium
intake and the need for slow, gradual weight gain. Women who are obese have a different weight-gain goal than other women.

A vegetarian diet requires special
attention so that you get enough
protein,
vitamin B12,
vitamin D, and zinc, in addition to the extra
folic acid, iron, and
calcium that all expectant mothers need. These
nutrients are vital to your fetus's cellular growth, brain and organ
development, and weight gain.

Calcium is an important nutrient, especially during
pregnancy. If you can't or don't eat dairy products, you can get calcium in
your diet from
nonmilk sources such as tofu, broccoli, fortified
orange juice or soy milk, greens, and almonds.

Stay active

Exercise during pregnancy can help your body best handle labor, delivery,
and recovery.
Moderate activity such as brisk walking or swimming is ideal
during pregnancy. Some women enjoy prenatal yoga. Drink plenty of water before, during, and after you are
active. This is very important when it's hot out.

What to avoid

Sources of food poisoning that may cause listeriosis
or toxoplasmosis infection, such as raw meat, poultry, or seafood;
unwashed fruits or vegetables; and cat feces or outdoor soil that cats commonly
use

Raw (unpasteurized) milk and cheeses made with raw milk

Fish that may contain mercury, such as shark, swordfish, king mackerel,
tilefish, more than
6 oz (0.2 kg) of white albacore
tuna per week, or fish caught in local waters that haven't tested as safe

Things that raise your core body temperature, such as doing hot yoga or using hot tubs and saunas

What's okay when you're pregnant

Sex causes no problems during an uncomplicated
pregnancy, and sexual interest often changes during different phases of a
pregnancy.

Working or going to school, if it isn't too physically
demanding, is usually fine during pregnancy. Scale back if you're becoming too
worn down as your pregnancy progresses. Talk to your doctor or midwife if
you are at risk for
preterm labor.

Travel is usually a safe choice until later pregnancy.
Talk to your doctor or midwife if you have any concerns. During your third
trimester, it's best to stay within a few hours of a hospital, in case of
sudden changes that need medical attention.

Second trimester

The second
trimester of pregnancy (from week 13 to week 27) is the time when most women start to look pregnant and may begin to wear maternity clothes. By 16 weeks, the top of your uterus,
called the fundus, will be about halfway between your pubic bone and your
navel. By 27 weeks, the fundus will be about
2 in. (5 cm) or more above your
navel.

You may find that the second trimester is the easiest part of
pregnancy. For some women, the breast tenderness,
morning sickness, and fatigue of the first trimester
ease up or disappear during the second trimester, while the physical
discomforts of late pregnancy have yet to start. Pressure on your bladder may
be less as the uterus grows up out of the pelvis.

Common symptoms you may experience during the second trimester of pregnancy
include:

Third trimester

The third trimester lasts from week 28 to the birth. Many women have some discomfort during this time as their belly gets bigger. You might have trouble getting comfortable so you can sleep. And you might have a few other aches and pains.

Common symptoms you may experience during the third trimester
include:

Breathing difficulty, since your uterus is now just below your
rib cage, and your lungs have less room to expand.

Mild swelling of your feet and ankles (edema). Pregnancy causes
more fluid to build up in your body. This, plus the extra pressure that your
uterus places on your legs, can lead to swelling in your feet and
ankles.

Difficulty sleeping and finding a comfortable
position. Lying on your back interferes with blood circulation, and lying on
your stomach isn't possible. Sleep on your side, using pillows to support your
belly and between your knees. Later in your pregnancy, it is best to lie on
your left side. When you lie on your right side or on your back, the increasing
weight of your uterus can partly block the large blood vessel in front of your
backbone.

Frequent urination, caused by your enlarged uterus and the
pressure of the fetus's head on your bladder.

Baby Development

Pregnancy is measured in
trimesters from the first day of your last menstrual
period, totaling 40 weeks. The first trimester of pregnancy is week 1
through week 12, or about 3 months. The second
trimester is week 13 to week 27. And the third
trimester of pregnancy spans from week 28 to the
birth.

First trimester

During the week after
fertilization, the fertilized egg grows into a microscopic ball of cells
(blastocyst), which
implants on the wall of your uterus. This implantation
triggers a series of hormonal and physical changes in your body.

The third through eighth weeks of growth are called the embryonic stage, during
which the
embryo develops most major body organs. During this
process, the embryo is especially vulnerable to damaging substances, such as
alcohol, radiation, and infectious diseases.

Having reached a
little more than 1 in. (2.5 cm) in length by the ninth week of growth, the embryo is called a
fetus. By now, the uterus has grown from about the
size of a fist to about the size of a grapefruit.

Second trimester

If this is your
first pregnancy, you'll begin to feel your fetus move at about 18 to 22 weeks
after your last menstrual period. Although your fetus has been moving for
several weeks, the movements have not been strong enough for you to notice
until now. At first, fetal movements can be so gentle that you may not be sure
what you are feeling.

If you've been pregnant before, you may notice movement
earlier, sometime between weeks 16 and 18.

During this time, the fetus is still building up body fat and starting to put on a lot of weight.
By the end of the second trimester,
your fetus is about
10 in. (25.5 cm) long and
weighs about 1.5 lb (680 g).

Third trimester

The third
trimester of pregnancy spans from week 28 to the
birth. Although your due date marks the end of your 40th week, a full-term
pregnancy can deliver between week 37 and week 42. During this
final trimester, your fetus grows larger and the body organs mature. The fetus
moves frequently, especially between the 27th and 32nd weeks.

After week 32, a fetus becomes too big to move around easily
inside the uterus and may seem to move less. At the end of the third trimester,
a fetus usually settles into a head-down position in the uterus. You will
likely feel some discomfort as you get close to delivery.

Emotions and Relationships

The emotional experience of pregnancy is different for
every woman. It's common to have mixed emotions and to feel uncertain—even if your pregnancy was
planned.

Because of the increasing hormones and the fatigue of
early pregnancy, mood swings can be worse than before pregnancy. Many women
worry that their baby will have a problem. Or they may feel anxious about childbirth.

Your relationships with family and friends may change as you adjust to having a new family member.

Health Concerns

Some women have health problems or concerns before they get pregnant. For other women, problems may come up during pregnancy. Your doctor or midwife will work with you to prevent or manage these problems to help you have a healthy pregnancy.

If you have a health problem or concern, you may have a high-risk pregnancy. This means that your doctor or midwife needs to follow you closely. It doesn't mean that something will go wrong during your pregnancy.

Pregnancy when you have health problems

If you have diabetes, it's important during pregnancy to keep your blood sugar in your target range. Planning diabetes care before and during the first few weeks of pregnancy can lower your risk of problems.

Obesity during pregnancy can increase the chance of problems. But most women who are obese have healthy babies. Your doctor will follow you closely and will plan a pregnancy weight gain that is right for you. Going on a diet during pregnancy is NOT recommended.

Managing asthma during pregnancy is important for
making sure you and your baby are getting enough oxygen. Most, but not all,
asthma medicines are safe to use during pregnancy.

Having epilepsy during pregnancy may require you to switch medicine or make other changes. But stopping medicine is not always the best solution. Having seizures during pregnancy can also harm the baby. Talk with your doctor about the best choice for you.

Some women carry group B strep bacteria in their vaginal area. A woman can pass this infection to her baby during vaginal birth. This infection doesn't cause symptoms, but you will be screened for it in your third trimester.

Immunizations help protect you and your baby from certain health problems. The flu vaccine and the tetanus, diphtheria, and pertussis (Tdap) vaccine are recommended for all pregnant women. It is safe to get these vaccines during your pregnancy. You may need to get other vaccines before or soon after your pregnancy.

Pregnancy after bariatric surgery may mean that you keep seeing the doctor who did your weight-loss surgery, along with seeing the doctor or midwife who is caring for you during pregnancy.

Domestic violence can happen more often and/or get worse when women are pregnant. It is dangerous for both the mother and the baby. For more information and to learn how to get help, see the topic Domestic Violence.

Planning for Labor

During your
prenatal visits, talk with your doctor or midwife about what you would like
to happen during your labor. Consider writing up your labor and delivery
preferences in a birthing plan, either in a
childbirth education class or on your own. You can
find examples of birthing plans on parenting websites.

Because no labor or delivery can be fully anticipated or planned in
advance, be flexible. Your experience after labor begins may be totally
different from what you expected. If an emergency or an urgent situation
arises, your plans may be changed for your own or your baby's safety.

Learn about labor and delivery ahead of time. Think
through your preferences for comfort measures, pain relief, medical procedures,
and fetal monitoring. And think through how you want to handle your first hours with your
newborn. To learn more, see the topic Labor and Delivery.

Planning to breastfeed

Plan ahead for breastfeeding by learning about breastfeeding and finding a
good
lactation consultant ahead of time and buying necessary
supplies. To learn more,
see the topic Breastfeeding.

Cord blood banking

Sometime during your pregnancy, you may get information about cord blood banking. Cord blood is the blood left in the umbilical cord after birth. Think about whether you want to bank your baby's umbilical cord blood for possible future use.

When to Call a Doctor

At any time during pregnancy

At any time during your pregnancy,
call your doctor or midwife immediately if you:

Have signs of
preeclampsia, a potentially life-threatening
condition, such as:

Sudden swelling of your face, hands, or feet.

Visual problems (such as dimness or blurring).

Severe headache.

Have pain, cramping, or fever with bleeding from the
vagina.

Pass some tissue from the uterus.

Think or know you have a fever.

Vomit more than 3 times a day or are too nauseated to eat or
drink, especially if you also have fever or pain.

Have an increase or gush of fluid from your vagina. It is
possible to mistake a leak of
amniotic fluid for a problem with bladder control.

At any time during your pregnancy,
call your doctor or midwife today if you:

Notice sudden swelling of your face, hands, or feet.

Have any vaginal bleeding or an increase
in your usual amount of vaginal discharge.

Have pelvic pain that doesn't get better or go away.

Have itching all over your body (usually in the evenings at
first, then throughout the day as well) with or without dark urine, pale
stools, or yellowing of skin or eyes.

Have painful or frequent urination or urine that is cloudy,
foul-smelling, or bloody.

Feel unusually weak.

Between 20 and 37 weeks

If you are between 20 and 37 weeks
pregnant, call 911 or other emergency services immediately if you:

Experience severe vaginal bleeding.

Have severe abdominal (belly) pain.

Are in your third trimester and have had fluid gushing or leaking from your vagina (the
amniotic sac has ruptured) AND
you know or think the umbilical cord is bulging into your vagina (cord
prolapse). If this happens, immediately get down on your knees so your buttocks
are higher than your head to decrease pressure on the cord until help arrives.
Cord prolapse can cut off the fetus's blood supply. (These measures apply to
you if you are as early as 24 weeks pregnant.)

If you are between 20 and 37 weeks
pregnant, call your doctor or midwife immediately or go to the hospital if you:

Regular contractions for an hour. This means about 4 or more in
20 minutes, or about 8 or more in 1 hour, even after you have had a glass of
water and are resting.

Unexplained low back pain or pelvic pressure.

Have noticed that your baby has stopped moving or is moving much
less than normal. See
Pregnancy: Kick Counts for information on how to
check your baby's activity.

Have uterine tenderness or unexplained fever (possible symptoms
of infection).

After 37 weeks

After 37 weeks, call 911 or other emergency services immediately if you:

Have had fluid gushing or leaking from your vagina (the
amniotic sac has ruptured) AND
you know or think the umbilical cord is bulging into your vagina (cord
prolapse). If this happens, immediately get down on your knees so your buttocks
are higher than your head to decrease pressure on the cord until help arrives.
Cord prolapse can cut off the fetus's blood supply. (These measures apply to
you if you are as early as 24 weeks pregnant.)

After 37 weeks of pregnancy,
call your doctor or midwife immediately or go the hospital if you:

Have vaginal bleeding (for light spotting, you can call at any
time on the same day).

Have had regular contractions for an hour. This means about 4 or
more in 20 minutes, or about 8 or more within 1 hour.

Have a sudden release of fluid from the vagina.

Notice that the baby has stopped moving or is moving much less
than normal. See
Pregnancy: Kick Counts for information on how to
check your baby's activity.

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